The Fertility Awareness Method.

Weight gain. Diminished sex drive. Mood swings. Spotting between periods. The list of birth control side effects goes on and on. Nevertheless, we persist. Not ready to get pregnant now, what choice do we have?

Before I get to the core of this piece I want to say this: the option of contraception is an important and essential choice for women. It is amazing that we can deliberately prevent conception during our fertile years by using any of the available contraceptive methods, side effects notwithstanding, to choose when, whether, and with whom to procreate. So if you have a method that works well for you, awesome—by all means stick with it. But for those wondering if there’s a way to prevent unwanted pregnancy without the irritating side effects, I’m here to say that yes, there is.

Ever heard of the Fertility Awareness Method? No, it is not the Rhythm Method, an ineffective method of contraception based on an average of past cycle lengths with no observations of impending ovulation in the current cycle. It’s also not the pull out (or withdrawal) method, although that is a real contraceptive practice—and way better than using nothing at all, admonishes Planned Parenthood. And, it’s absolutely not a guessing game when, in the heat of the moment, you quickly calculate how far you are from 14 days since your last period and decide that just this time, it’ll be fine. Fertility Awareness Methods, or FAMs, are actually a set of scientifically valid ways of tracking your ovulation to determine when during the month you’re fertile, and when you’re not, so that you can use barrier protection (or abstain) only on the days when it matters, and just go for it the rest of the month.

You will sometimes see the term Natural Family Planning, or NFP, used alongside FAM; they’re the same except that people who practice NFP abstain from sex during the fertile period rather than using another form of birth control. But when it comes to the overall practice of “fertility awareness,” you may find that the term is often used to refer to just one method for observing fertility cycles (i.e., just the temperature method, or just the calendar method). While it’s true that these observations of your cycle will give you “fertility awareness,” I’m guessing you don’t just want to be aware, but want to be knowledgeable and competent enough to use that information to prevent pregnancy. Most resources strongly recommend that women who use this approach for birth control should carefully record daily observations of at least two fertility signs: the quality of your cervical fluid and your waking temperature (also called Basal Body Temperature, or BBT). Sometimes it’s also recommended to check the position of your cervix. Let’s look at each more closely.

After menstruation, estrogen levels are low and cervical secretions are dry or non-existent. Cervical fluid becomes wetter as ovulation nears and estrogen levels rise, and then take on an egg white-like quality when fertility is at its peak. Throughout your cycle you may observe fluid that is milky, sticky, crumbly, rubbery, slippery and stretchy, opaque or clear. Maybe you’ve noticed these changes before and didn’t know what they were. If you choose to use FAM, you’ll learn to differentiate between the different types of cervical fluid and understand what they tell you about where you are in your cycle.

Basal Body Temperature is similarly affected by shifting hormone levels throughout your cycle. Before ovulation, a woman’s temperature will typically range between 97.0 and 97.7 degrees Fahrenheit. About a day or so after ovulation, the rise in progesterone will cause her temperature to increase by about half a degree, and stay elevated until her next period. So charting your temperatures can accurately tell you when you’ve ovulated. But remember—sperm can stay alive inside a woman’s body for 3-5 days, so if you had unprotected sex a couple of days before ovulation you’d be at risk of becoming pregnant. In other words, you can’t just wait for the temperature shift to tell you when you’re fertile. The unsafe window opens before that!

The last sign to check is cervical position. Did you know that your cervix moves and changes throughout your cycle? It’s normally firm and closed, and sits fairly low, but it rises, opens up, and becomes fairly soft and mushy, as you approach ovulation. These changes occur to make it easier for the sperm to pass through the cervix into the uterus and then the fallopian tubes where it intends to fertilize an egg. Of course, we’d be using this information to prevent that from happening (sorry little guy).

Now I’m not about to tell you that FAM is the easiest approach to pregnancy prevention. It requires a few minutes of tracking every day, and there is a learning curve, so you need to develop a new skill and wait until you’re up to speed to use it. You may also have to find a practitioner who can teach you how to use it properly. In terms of use, FAM is not quite as convenient as taking a pill every morning, getting a shot every few months, or having an IUD inserted that you (hopefully) completely forget about for a few years. The upside of course is that you don’t have to deal with any of the potentially negative side effects of any of those other methods. But the real prize is this: FAM works. Exceedingly well. In fact, if used correctly, it’s 98% effective—the same as condoms, nearly as effective as the pill (99%), and more effective than a diaphragm (94%).

However, none of these methods works perfectly when used by humans who err. For instance, according to Planned Parenthood, condoms are only 85% effective in conditions of real world use—meaning that 15 out of 100 people who use condoms for birth control will get pregnant each year. Do you find that statistic surprising? I did, until I realized that many people who use condoms may not use them correctly (think of the impulsive teenager who has only had one or two experiences with a condom in his lifetime), and those who do have a risk of failure that’s much lower than that. In other words, not all condom users are the same. Which brings us to the big question: Can you practice FAM correctly? Would you be the kind of FAM user who forgets to observe some signs sometimes? That’s no bueno.

But since it’s 2018, you’re in luck: technology can help. Our friends at DAYSY have found a sweet spot between tracking multiple fertility signs all on your own and relying entirely on an outside device to manage your birth control. DAYSY is a fertility monitor that tracks your temperature and predicts your fertile period using data from your cycle and thousands of other DAYSY user cycles, with a reported accuracy rate of 99.3%. Using DAYSY, the fertile phase is longer than the fertile phase using the Symptothermal Method (where you track the multiple fertility signs on your own)—meaning that, in exchange for the convenience of using DAYSY rather than tracking everything yourself, there are more days during which you cannot have unprotected sex. But if you’re not up for tracking carefully and consistently, then this is a moot point. Keep in mind that there are many, many period tracking apps out there that do exactly that—track your period—and are not able to tell you when you’re fertile. Don’t make the mistake of thinking these are fertility awareness method devices!

It may seem overwhelming, but I urge you not to be timid about learning to track your own fertility while remaining reliant on other forms of birth control that cause so much grief for womankind. FAM is a fully autonomous and, in my view, empowering, method of fertility tracking. For all our talk about having control over our own bodies and not wanting to put our health into the hands of others, we women sure do rely heavily on doctors and pharmaceutical companies for convenient contraception. But FAM is there for you if you want it. Maybe it’s time to take these matters into our own hands?